Can you please give us a brief overview of your stroke pathway, in terms of where you are positioned on the post-stroke journey and the types of interventions you provide?
St John & St Elizabeth Hospital’s Stroke Clinic is one of the UK’s best equipped private facilities for post-stroke care and rehab, and we offer an extensive range of services, personalised treatment programmes, and all the clinical and emotional support necessary for a speedy recovery.
After the medical emergency of a stroke has passed, it’s really important to uncover the root cause and tailor a rehabilitation programme around this. At our Stroke Clinic, we provide an intense level of support with a whole team of experts, including physiotherapists, occupational therapists, dieticians, speech & language therapists, and neuro-psychologists, as well as a stroke consultant, who visits patients daily. The team is supported by an excellent nursing team who assess our patients’ care needs, administer medications, and monitor vital signs such as blood pressure, pulse and temperature.
As strokes can affect such a large variety of functions, the team also has access to the hospital’s other consultants, who come from a number of disciplines, including urologists, cardiologists and ophthalmologists.
As we’re a rehab service, we don’t offer medical or surgical interventions. However, when a patient arrives at our clinic, as well as a full assessment, which includes extensive investigations (such as blood tests, respiratory function test and echocardiogram), the consultant conducts a full review of previous investigations and results to ensure continuity of care.
Medical investigations are done very quickly at our Stroke Clinic. In the NHS, some of these are done in outpatients, so it can take a while to get the results.
This means it can be some time before the cause of the stroke is understood. Here, we do them immediately and act upon them straight away. This is really important as we can then treat the root cause and help prevent another stroke.
Are there any elements to your approach that you believe sets you apart from other such services – or which other stroke care providers could learn from?
Compared to an NHS service, we have the ability to see patients for longer. Our standard package is 3 weeks, but patients can stay with us for longer if needed.
Our three-week fixed price package covers everything, including care, accommodation and meals, therapy, dietetics, drugs and routine tests. As well as being completely transparent, this means we can take away some of the stress from patients and families, in an already difficult time. And if patients are able to leave earlier than the three weeks, we give them a pro-rata refund for their unused days.
With the challenge of insurance and the cost of a stroke rehab service, we want to make sure our patients get the most out of their time with us. As such, all calls to us are triaged by a clinical professional.
Receiving guidance from a medical perspective right from the start is not only really helpful for loved ones, but also means patients have the best chance at recovery.
What would you say are the biggest barriers / challenges to you in delivering the best possible patient outcomes?
For us, it’s really important that people are getting the most out of their time with us and can achieve the best outcomes possible. Making sure patients come to us at the right time, so we can make this a reality, is our biggest challenge. Insurance companies only cover a set amount of treatment time, so this plays a role as well.
Once people have decided to stay with us, a big challenge can be getting doing enough therapy with them. We aim for morning and afternoon sessions, but some days, this can be a struggle if a patient is having a difficult day. As a result, we tailor treatment to each person, and adapt on a daily basis in response to patient feedback.
Please tell us about the make-up of your team in terms of roles / skills / multi-disciplines etc. Has this skillset changed in recent years? If so what are the reasons for these changes?
As mentioned, we have physiotherapists, OTs, speech & language therapists, a neuro-psychologist, dietitians, the nursing team and the patient’s dedicated consultant who visits them each day.
Our team structure hasn’t changed over the last few years as we find this setup really works.
However, most services don’t have a neuro-psychologist. They’re trained to assess and treat people who are having issues with their memory, concentration, planning, language, reasoning and other aspects of learning and understanding. When any of these faculties are lost or impaired after a stroke, it can lead to a grief reaction, and people can feel anxious and depressed. As such, having a neuro-psychologist available who can help people through this is really huge.
It also means our patients have the opportunity, and a safe space, to talk with a trained professional who can help them process challenging feelings that have arisen as a consequence of the stroke – such as changes in identity, low self-worth and frustration.
If relevant, please describe your approach to families and loved ones of patients in terms of a) harnessing their support for the benefit of your patients/clients and b) supporting them through the difficult period after a stroke.
A stroke is life-altering. Most of the time, families aren’t prepared for it or what happens next. They often struggle to prepare for their loved one’s return home and don’t know what to expect. The patient will also need help adjusting, and support with planning for the future. At our clinic, we help them navigate the journey and hold their hand every step of the way.
When a patient arrives at our clinic, we have a family meeting to set goals and put steps into place to achieve these. We then have weekly family meetings to discuss progress and set new goals.
We always encourage the family to be present during these sessions so that they’re involved in care decisions, and to help them feel more confident about what will happen once their loved one is ready to be discharged.
Once patients are ready to leave the clinic, we can arrange ongoing care, therapy, and any equipment they may need going forwards. If patients are going back home, we discuss their home setting and if they live close enough, we will visit their home and make recommendations.
All our therapy services are also available in our outpatient department, and this is of great benefit to those who want to continue their rehabilitation journey with us.
With stroke rates rising, are you experiencing growing demand for your service? How are you meeting this demand?
We’ve seen a pretty steady demand for our services over the last decade. However, we are seeing younger people in need of our services. From what we see, this is mainly lifestyle and stress related.
This demands of these patients will be different, as they may have young families and be in work. They may not be able to go back to their job, have to retrain, or not be able to care for their family in the same way, so we have to take these aspects into consideration as well.
‘Patient-centred’ is a term often overused in neuro-rehab – please explain what this really means and how you embrace it as a stroke care service?
This goes back to making sure the patient knows what they want to achieve with us, which starts from the moment we talk to them before they come in. We’re constantly talking to families and patients so we can help them set achievable goals.
As an example, a recent patient liked to do crosswords on their iPad. However, their memory wasn’t as good as it could be. Instead, we downloaded some other games to their iPad which would keep them stimulated. In turn, this became part of their rehab, as they were using their memory and function in order to complete the games.
Another example is when we take people to St John’s Wood High Street nearby, which has lovely shops and cafes. This helps improve spacial awareness and navigating roads, with the aim of helping people get back to a normal life as quickly as possible. Often, people will have spent weeks in hospital, and so being able to go to the shop and do something normal can give a huge confidence boost and make a world of difference.
Is your use of technology changing, or has it changed recently, to better serve your patients?
In some ways, yes. However, we still mainly focus on hands-on rehab as this is an evidence-based effective treatment.
We do incorporate technology as we see fit and depending on a patient’s needs, such as the interactive iPad games.
We also have different bits of kit, such as a grip strength, movement and coordination tool that can be set up on a phone. The patient can then practice in their own time and can hire the kit when they go home if they want to keep using it.
We also have devices that help people work on their upper limbs skills and an FES (functional electrical stimulation) machine, which can be used for both upper limb and lower limb issues. This uses electrical stimulation to activate the muscles and can help patients complete more rounds of repetitive movements.
St John & St Elizabeth Hospital’s Stroke Clinic in North West London is designed for people who have had emergency treatment for a stroke and need a calm space to rest and recover during the crucial following days. The clinic also provides ongoing care for people once they’ve returned home, so they can keep making progress and live life to the fullest.
The clinic is a fully accredited BUPA rehabilitation unit, and the multi-disciplinary team is led by Consultant Physicians and Neurologists who hold senior positions in London Teaching Hospitals.
Find out more at www.hje.org.uk/stroke
Call the Stroke Clinic on 020 7806 4075
